Steroids and Acne: Understanding the Connection, Prevention, and Treatment Options

People use anabolic and corticosteroid steroids for various medical and non-medical purposes, like treating inflammatory conditions or enhancing athletic performance.

However, prolonged or misuse of steroids could lead to several side effects, one of the most common being acne.

Steroid-caused acne, often characterized by the sudden onset of severe acneiform eruptions, poses both a dermatological and cosmetic concern.

This condition arises due to the complex interaction between steroids and the skin’s sebaceous glands, leading to increased sebum production, inflammation, and bacterial growth.

Thus, understanding the link between steroid use and acne might guide you with effective prevention and management strategies to reduce the chances of getting acne.

What Is Steroid Acne?

Steroid acne is a specific type of acne that could occur from the use of corticosteroids, anabolic steroids, or other steroid medications. It happens by the sudden beginning of acneiform eruptions, which are inflammatory and can be pustular or papular.

Steroid acne could affect people who are on prescribed steroids for their specific medical conditions or for people who misuse anabolic steroids for athletic performance or bodybuilding.

Steroid acne typically appears on the chest, upper back, and face, and its beginning may take weeks to manifest. However, factors influencing the development of steroid acne include age, susceptibility to acne, dosage, and treatment duration.

Symptoms of Steroid Acne

Steroid acne could manifest as various types of skin lesions on areas such as the chest, face, neck, back, and arms.

These symptoms include:

• Open and closed blackheads and whiteheads (comedones)
• Small red bumps (papules)
• White or yellow spots (pustules)
• Large, painful red lumps (nodules)
• Cyst-like swellings (pseudocysts)

Picking or scratching the acne may lead to red marks from recently healed spots, dark marks from old spots, and potential scarring. In cases where the steroid acne is of the acne vulgaris type, the spots may appear more uniform compared to regular acne.

Steroid Acne Clinical Features

• Acne vulgaris

  Acne vulgaris is a dermatological condition that may manifest with uniform lesions on sites prone to acne, such as the face, and could be worsened by steroid use.

  Steroids can worsen the tendency for acne, leading to more consistent and widespread lesions than typically seen in acne cases.

  People experiencing steroid-induced acne vulgaris may notice a worsening of their existing acne condition, with lesions appearing more structured and uniform in their presentation.

  This worsening of acne vulgaris by steroids can be distressing for people who are affected, as it often affects highly visible areas like the face, leading to concerns about appearance and self-esteem.

  Thus, seeking guidance from dermatological professionals could help alter treatment plans to address the specific needs of people dealing with steroid-induced acne vulgaris.

• Malassezia Folliculitis

  People experiencing the worsening of acne vulgaris due to steroid use may also develop a condition known as Malassezia folliculitis. It is indicated by the proliferation of Malassezia yeasts, resulting in itchy superficial papules and pustules, especially on the chest and back.

  However, Malassezia folliculitis is often mistaken for acne vulgaris and requires a distinct approach to management. Dermatological evaluation is essential to confirm the diagnosis and create a suitable therapy according to the specific characteristics of Malassezia folliculitis.

Causes Of Steroid Acne

1. Prescription Corticosteroids

   Corticosteroids like Glucocorticoids used in medical treatments post-organ transplant surgeries and during chemotherapy might increase the occurrence of steroid acne.

   Steroid acne typically appears after several weeks of treatment with prescribed corticosteroids, especially in people with lighter skin. The severity of steroid acne is influenced by factors such as the dosage of steroids, the duration of treatment, and a person’s predisposition to acne.

   The use of masks in inhalation therapy for corticosteroids may increase the possibility of it appearing on the face.

   Misuse of anabolic steroids in bodybuilding could also lead to the development of health issues, including acne, with up to 50% of bodybuilders using steroids experiencing steroid acne.

2. Anabolic Steroids Used in Bodybuilding

   Anabolic steroids used in bodybuilding are synthetic variations of testosterone, a sex hormone that is often misused to enhance muscle growth and athletic performance. High doses of testosterone, another common anabolic steroid, may also contribute to the occurrence of acne outbreaks. Sustanon and Deca are popular formulations used by bodybuilders that might lead to steroid acne.

Treatment Options For Steroid Acne

1. Oral antibiotics

   Oral antibiotics from the tetracycline group are prescribed in cases of steroid acne, particularly for severe instances or when scarring is present. These antibiotics, such as doxycycline, minocycline, and tetracycline, could effectively treat steroid acne by targeting the bacteria that worsen acne and may also possess anti-inflammatory properties.

2. Benzoyl peroxide

   Benzoyl peroxide is an effective antiseptic agent utilized in the treatment of acne to target and eliminate acne-causing bacteria while reducing inflammation. It works by delivering oxygen into the skin’s pores and killing the bacteria responsible for acne. Benzoyl peroxide may help remove excess oils and dead skin cells.

   When using benzoyl peroxide, it is crucial to apply it to the entire face, not just on visible spots, as acne could develop from microscopic sites. Consistent and gentle application is key to effectiveness, while harsh scrubbing should be avoided to prevent further skin irritation.

3. Phototherapy

   Phototherapy utilizes blue and blue-red light to treat acne. Blue light may target acne-causing bacteria, reduce inflammation, and improve skin clarity, while blue-red light combines anti-inflammatory properties with bacteria-killing effects, which might reduce the chances of excess acne development.

   The wavelengths of blue and blue-red light penetrate the skin, targeting sebaceous glands and reducing the production of oil. Phototherapy may prevent future breakouts and promote quicker healing of existing lesions by destroying the bacteria responsible for acne.

4. Retinoids

   Retinoids are a class of medications utilized in the treatment of acne and various dermatological conditions, which might help reduce sebum production and address acne concerns.

   It could help regulate cell turnover, prevent the plugging of hair follicles, and reduce inflammation, which might help in the development of acne.

   They may help to keep the pores clear and reduce the likelihood of breakouts by supporting the removal of dead skin cells. Retinoids could also help reduce the formation of new comedones.

   Topical retinoids are used in the treatment of mild to moderate acne, while oral retinoids, such as Isotretinoin, are meant for severe cases.

5. Minocycline

   Minocycline is a tetracycline antibiotic that could help manage acne by reducing inflammation and targeting specific chemicals that may contribute to skin swelling.

   It may penetrate the skin deeply, reaching the sebaceous glands where acne develops, leading to improved efficacy in treating stubborn acne lesions.

   Minocycline could hinder the growth of bacteria on the skin, reducing inflammation and suppressing the production of certain chemicals that may contribute to the development of acne.

6. Tetracycline

   Tetracycline may help reduce steroid acne by decreasing sebum production. It could hinder bacterial protein synthesis, thereby reducing the development of acne-causing bacteria on the skin. Tetracycline might help to alleviate inflammation and prevent the formation of new acne lesions.

   While tetracycline can be effective in managing steroid acne, it is crucial to stay aware of potential adverse effects such as gastrointestinal upset, photosensitivity, and the development of resistant bacterial strains.

7. Isotretinoin

   Isotretinoin is a retinoid that may reduce skin oil production, prevent new pimples from forming, and promote skin renewal. It is usually reserved for severe cases of acne that have not shown any improvement with topical medications or antibiotics.

   Isotretinoin may treat severe nodular acne, reduce the number of acne lesions, prevent scarring, and improve overall skin condition. However, people must adhere to strict monitoring protocols, including regular blood tests and pregnancy tests, while taking Isotretinoin to ensure safety and effectiveness in treating severe acne.

8. Doxycycline

   Doxycycline may effectively target acne and calm the skin by reducing inflammation through the interference of specific protein production. It belongs to the tetracycline antibiotic class and is known for its ability to reduce acne-causing bacteria and lower the redness and swelling associated with acne lesions.

Related:

• Side-Effects Of Steroids On Eyes
• What Is Steroids Injections Abuse And Its Side-Effects?
• Steroids Withdrawal Symptoms, Signs, And Detoxification

Prevention Tips for Steroid Acne

To prevent steroid acne, people should prioritize proper skincare practices. Here are a few tips for effective steroid acne prevention.

• Skincare Routine: Creating a consistent skincare routine that includes gentle cleansing, moisturizing, and using non-comedogenic products could help prevent acne flare-ups.
• Monitoring and Adjustment: Regular monitoring of skin health during steroid use and being attentive for any signs of acne development might help in early intervention and adjustment of treatment plans.

Frequently Asked Questions

1. Can Topical Steroid Creams trigger Steroid acne?
   Topical steroid creams like clobetasone could worsen steroid acne due to their potential to disrupt skin barrier function, increase oil production, and induce inflammation. Prolonged use of potent steroids may lead to acneiform eruptions, emphasizing the importance of cautious application.
2. Are There Specific Foods That Can Worsen Steroid Acne?
   Foods with dairy products, processed foods, and the ones with excess sugar and high glycemic index may worsen acne by increasing inflammation and oil production. Maintaining a nutritious diet rich in vegetables, fruits, whole grains, and lean proteins could help you manage acne.
3. Is Steroid Acne More Common in Athletes Than in Non-Athletes?
   Steroid acne could be higher in athletes due to anabolic steroid misuse for performance enhancement. Factors like age, dosage, and treatment duration influence the occurrence of steroid acne. Proper education, monitoring, and adherence to safe steroid practices are essential in preventing steroid acne.
4. Does Steroid Acne Leave Permanent Scars on the Skin?
   Steroid acne can potentially leave permanent scars on the skin. The severity of scarring varies based on personal factors like skin type, treatment efficacy, and duration of the condition. Early intervention and proper management might help minimize scarring.

Conclusion

Steroid acne is a specific type of acne triggered by high levels of corticosteroids in the body. It could make you conscious of yourself due to visible marks on the face. However, proper diagnosis is essential to differentiate steroid acne from other forms of acne.

Understanding the root causes, recognizing the symptoms early, and adopting preventive measures may help you manage steroid acne effectively.

You could also include proactive skincare habits to minimize the chance of developing steroid acne and maintain clearer skin.

Maintain a gentle skincare routine by using non-comedogenic products to avoid clogging pores and worsening acne.

Focus on a diet rich in fruits, lean protein, and vegetables while avoiding excessive sugar and dairy, which could trigger acne outbreaks.

Moreover, keep your face clean and avoid touching it frequently. Change pillowcases and towels regularly to reduce exposure to bacteria.

Thus, you might significantly reduce the likelihood of developing steroid acne and enjoy healthier skin by combining these prevention tips into your daily routine.